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&� x�ao-oo2o City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit ��� :� <br /> , . _., . . . -.x.,�. s ,>., .�.>> _ ,., . , , <br /> Owner's Name ` � ��,,,� ��.r,� Owner's Phone Number �� � �� �G <br /> Owner'sAddress S /j)�s'7 Z � <br /> Fee Simple Titleholder Name Titleholder Phone Number ��� � <br /> Fee Simple Titleholder Address <br /> .. . , .. �k° � �,�;^ft;w.�:�. -°�a=ti <br /> ��x��� <br /> Job Address Lot # C� <br /> Sub Division Parcel # <br /> e , . - '�.:a+ ..�y,c:;=.sF ,._ , _ .. - _ _ . ,� . ,�:=,�.���*•k,.�: •. , � .e;�.:.aa�'��.:a_:s�.es <br /> � � - - _ _ _ »'!'.av'nr, <br /> Bio-Hazard Waste Storage - ANNUAL � Fumigation Tent <br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> a Controlled Burn � Hood Installation <br /> � Emergency Generator < 30 kw � LP/Natural Gas-Installation <br /> � Emergency Generator > 30 kw � LPlNaturel Gas-ANNUAL Sale <br /> � Fire Protection Maintenance - ANNUAL a Places of Assembly-ANNUAL <br /> � �y emi � er ❑ <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ C� � Sprinkler System Installations <br /> Hood Suppression � ❑ � ❑ � � Standpipes (Sprinkler Sys) <br /> � Fire Alarm Installation � Torch Roofing/Tar Kettle <br /> � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Fire Works <br /> � Flammable Application- ANNUAL Valuation of Project <br /> � Fuel Tanks <br /> � Other: <br /> F � - e:�*5�°A�b,; �..,.:aa;:k:� � .. :,-��?�C'�',:�.,i�...., _ a �:- . ° S2k!%d�'�-:x`$+'• - u�:."�caa <br /> Contractor .���: >�:�<�;..�•�:�r�:�„=_'. .,, <br /> ��:. <br /> Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> ELECTRICIAN <br /> Company <br /> 5ignature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> 'LUMBER <br /> Company <br /> 3ignature Registered Y/ N Fee Current Y/ N <br /> Address <br /> Lice�se # <br /> uIECHANICAL <br /> Company <br /> iignature Registered Y/ N Fee Current Y/ N <br /> Address <br /> License # <br /> )THER <br /> Company �,.i � /i,CG E v � <br /> tignature T l_ <br /> Registered N Fee Current N <br /> Address <br /> License # �c� <br /> lirections: <br /> Fill out application completely <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over $2500, a Notice of Commencement is required (Mechanical work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (http:!/appraiser.pascogov.com) <br />